Category Archives: Miami Herald

So much bluster, but foster kids’ drug nightmare continues

Miami Herald
By Fred Grimm
Gabriel Myers died for nothing.

His shocking death supposedly galvanized Florida. It would mean something, this suicide of a foster kid who had been drugged into nether-consciousness with antidepressants and antipsychotics never intended for any child, much less a 7-year-old.

A new law would be crafted. State-sponsored zombification of foster kids would be stanched. Something would be done.

More like nothing.

“I was shocked. I was devastated,” said Mez Pierre, a young survivor of the unrestrained psychotropic regimes used to addle Florida foster kids.

THE PERPLEXING PUSHBACK

Pierre, 23, joined a number of child advocates, state officials, political leaders and judges in the Gabriel Myers Work Group formed by the Department of Children & Families. They met a dozen times over the past year, exploring legislative fixes for this stunning propensity to subdue foster children with adult-strength pharmaceuticals.

The group was born out of our collective shame. Gabriel Myers had been addled with Lexapro, Zyprexa and Symbyax — a drug cocktail no real parent would countenance. On April 15, 2010, Gabriel locked himself in the bathroom of his Margate foster home, coiled a shower hose around his neck and shocked Florida into . . . nothing.

The widely supported bill designed to regulate the drugging of foster kids disappeared in the House of Representatives this week. Medical and drug-industry lobbyists, and a single powerful legislator, Rep. Paige Kreegel, chairman of the Health Care Services Policy Committee, managed to waylay the bill.

Bernard P. Perlmutter, director of the University of Miami’s Children & Youth Law Clinic, was surprised that “pushback came from doctors and psychiatrists, since the bill did little more than codify existing medical ethics standards and laws regarding consent from a child’s parents or judge, and assent from the child, before psychotropic medication could be administered.”

Kreegel feigned unfamiliarity with Myers’ case. “I am shocked that the chairman never heard about Gabriel Myers, especially after the months of work by a task force of leading experts and then work by the Senate,” said Broward child advocate Andrea Moore. “Unfortunately, we know there are other children who have been harmed by the unfettered use of these drugs as chemical restraints. If a highly publicized death is not enough to galvanize the Legislature, I do not know what will do it.”

SPIRITS IN SHACKLES

Mez Pierre now understands Florida’s priorities: Doctors matter. But foster children . . .

“They sent foster kids a message.” he said.

“You’re just not important enough to protect.”

Pierre, 23, grew up in so-called “therapeutic” foster homes from age 5 to 18, shuffling from one zombie warehouse to another, where psychotropic drugs left him perpetually listless, filled his head with strange, often suicidal thoughts and caused serious physical side effects.

The brutal effects ended when he left foster care at age 18 and quit the psychotropics. Without the pills, the supposedly unruly young man has finished three years at Broward College. “But what happened to me, what happened to Gabriel, it’s still going on,” Pierre said.

And all the work group meetings. All the talk. All the work. As if foster kids mattered.

It came to nothing.

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Foster kids lose

Miami Herald
OUR OPINION: Still subject to over use of psycho-tropic drugs

State Sen. Rhonda Storms, a Valrico Republican, put up a Herculean fight on behalf of Florida’s foster kids this week, but a powerful bloc of doctors and psychiatrists defeated her in the Florida House.

The House leadership could have prevented this travesty. Instead, it caved to Florida’s powerful medical lobby and sacrificed some of the state’s most vulnerable residents.

The battle was over use of psycho-tropic drugs on youth in state care. After the 2009 suicide of 7-year-old foster child Gabriel Myers in Margate, the Department of Children & Families hired former Florida Department of Law Enforcement Deputy Commissioner Jim Sewell to investigate how drugs are used to control unruly foster kids.

Mr. Sewell pulled no punches in his report. Foster parents and doctors often resort to strong anti-depressants to keep children with emotional problems in line. Treatment of their underlying psychological problems take second place to keeping them drugged up.

Gabriel had been prescribed several such drugs before he hung himself, including anti-depressants linked to an increased risk of suicide among children.

The DCF sought better oversight of how doctors prescribe psychiatric drugs to foster children. The bill, sponsored by Sen. Storms, would have required doctors to seek the “assent” of older foster kids before they could be medicated and upheld current law requiring doctors to get consent from a parent or a judge in most cases before using drugs.

That’s reasonable — and, more important, in the child’s best interests. But physicians fought, saying they didn’t want government telling them what to do. Republican state Rep. Paige Kreegel, a Punta Gorda doctor, blocked the bill from even being heard in the House, though it had passed easily in the Senate.

Sen. Storms tried every legislative maneuver available to get around Rep. Kreegel, but the physicians won the day, and Florida’s foster children are worse off for it.

DCF ought to seek another way to control use of these medications until reason prevails in the House.

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Drug’s use again in spotlight

Miami Herald
The mother of a Broward teen who died in 2003 believes it was because of an anti-psychotic drug he should not have been prescribed.
BY NIRVI SHAH

A Broward doctor reprimanded by the Food and Drug Administration for his drug-prescribing practices is facing accusations in a civil suit that he caused the death of a Weston teen after prescribing an anti-psychotic drug not approved for use in adolescents.

Norma Tringali of Tamarac believes the drug Seroquel, which Dr. Sohail Punjwani prescribed to her son Emilio, played a role in his death seven years ago. Punjwani is the same physician who was treating 7-year-old foster child Gabriel Myers before he committed suicide last year.

Earlier this week, pharmaceutical giant AstraZeneca agreed to pay state and federal government agencies $520 million to settle an investigation into the company’s marketing practices, which the Department of Justice said encouraged doctors to use Seroquel for young and elderly people for indications not approved by the FDA.

The settlement will yield about $8.5 million for Florida, split between the state’s Medicaid program, general revenue fund and a reward program for reporting Medicaid fraud.

Tringali’s case against Punjwani is expected to go to trial later this year.

All the other doctors and institutions named in the suit have settled with Emilio’s family, said her lawyer, Michael Freedland.

In the meantime, for Tringali, the civil penalty AstraZeneca has said it will pay provides some resolution.

“That is the thing — that is the answer,” Tringali said, through tears. “Emilio was taking something recommended for adults, not kids.”

Punjwani and his attorneys did not return several phone calls seeking comment.

After a year in Punjwani’s care, Emilio, who played water polo, had a heart attack and died. He was a junior at Piper High School in Sunrise. The lawsuit alleges that Punjwani’s care “deviated and departed from the prevailing professional standard of care exercised” by most doctors.

It goes on to say that Punjwani failed to monitor the effects of a combination of anti-psychotic drugs on Emilio’s heart, failed to perform regular cardiac testing and failed to consult with a cardiologist or other doctor with more experience with the heart-related side effects of anti-psychotic drugs, among other things.

But it is not certain whether the settlement will have a direct effect on the suit against Punjwani, said Tringali’s lawyer, Weston attorney Michael Freedland.

“She was always convinced that these drugs caused his death,” Freedland said of Emilio’s mother. “For her this settlement was some kind of vindication in a sense. It doesn’t necessarily relate to the exact same issue.”

Freedland’s office was simultaneously working on Tringali’s case and the whistleblower case that led to this week’s settlement with AstraZeneca. But rules about whistleblower suits meant they could not share anything about that case with Tringali until the settlement became public this week.

Punjwani was reprimanded by the FDA because he failed “to protect the rights, safety and welfare” of children enrolled in clinical drug trials.

“Your failure to conduct the requisite safety measures contributed to the unnecessary exposure of pediatric subjects to significant overdoses, which jeopardized the subjects’ rights, safety and welfare,” the FDA wrote.

Early last year, drugmaker Eli Lilly pleaded guilty to illegally marketing the anti-psychotic drug Zyprexa for unapproved uses. Freedland’s firm also worked on that case, which netted a $1.42 billion settlement.

“The issue relates to these drugs,” Freedland said. “The way Dr. Punjwani treated Emilio Villamar and the manner in which these drugs were prescribed is a picture of everything that’s wrong with this industry and the relationship between doctors and pharmaceutical companies.”

The settlement says that AstraZeneca targeted its illegal marketing of Seroquel at doctors who do not typically treat schizophrenia or bipolar disorder, including physicians who treat older patients, young patients and primary care doctors and to psychiatrists and other physicians for uses that were not approved by the FDA as safe and effective.

The civil penalty will repay Medicaid, Medicare and other programs that were billed for the drug, although it was being prescribed incorrectly.

In a statement, AstraZeneca said under the agreement, it still denies the allegations.

However, the international company, with U.S. headquarters in Delaware, entered into a corporate integrity agreement with the Office of Inspector General of the United States Department of Health and Human Services that will last for five years.

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Effort to protect children from overmedication fails

Miami Herald
The product of state child welfare administrators’ half-year of soul-searching, a bill to protect foster kids from powerful mental health drugs is killed by doctors.
BY CAROL MARBIN MILLER AND MARC CAPUTO
April 30, 2010

TALLAHASSEE — When a heavily medicated foster child died of an apparent suicide, the response seemed obvious: Better oversight of the way doctors prescribe psychiatric drugs to children in state care.

But in the waning days of Florida’s 60-day lawmaking session, what looked like common-sense regulation to some has no chance of passing, a victim of conflicting ideologies and the power of doctors and psychiatrists in the Capitol who don’t want government telling them what to do.

The bill, sponsored in the Senate by Sen. Ronda Storms, a Valrico Republican, would have required doctors to seek the “assent” of older foster kids before they could be medicated, and upheld provisions of current law that require doctors to gain consent from a parent or judge in most cases before a foster child could be drugged.

“I’m extremely disappointed,” said Jim Sewell, a former lawman who headed up a six-month investigation for the Department of Children & Families into the April 16, 2009, death of 7-year-old Gabriel Myers. “For all of us, this was a real involvement of the heart, and to see it not get codified into law was a big disappointment.”

Sewell, a former Florida Department of Law Enforcement deputy commissioner who is now special assistant to DCF Secretary George Sheldon, presided over a series of public hearings on Gabriel’s death, and published a surprisingly frank report last November. Gabriel had been prescribed several mental-health drugs in the months before his death, including anti-depressants linked to an increased risk of suicide among children. Sewell’s report contained a host of recommendations for changes in state law — many of which were in the bill.

Among other things, the bill would have banned children in state care from being enrolled in clinical drug trials — a provision that gained momentum last month when Gabriel’s psychiatrist, Dr. Sohail Punjwani, received a stern warning from federal regulators over his conduct in a drug trial for an undisclosed psychiatric drug.

The measure flew through the Senate with unanimous votes in every committee. But in the House, Rep. Paige Kreegel, a physician, refused to even hear the bill in his Health Care Services Policy Committee.

“I don’t feel right now that we are in definite need of any additional regulation in the state,” said Kreegel, a Punta Gorda Republican. “There’s all kinds of regulation.”

Kreegel said he didn’t know the particular facts behind the case of Gabriel Myers — who authorities say hanged himself with a shower cord in the bathroom of his Margate foster home. But he said Storms’ legislation would effectively have stopped psychiatrists from prescribing medicine to needy children.

Kreegel called some of Storms’ statements about out-of-control doctors “baloney.” Storms was outraged that Kreegel was able to kill the bill — which was one of DCF’s highest legislative priorities.

“How can anyone be against protecting children?” Storms said.

Storms spent a feverish week trying to get around Kreegel’s procedural maneuver. She amended her bill onto a must-pass piece of legislation governing DCF. Then she persuaded Senate leaders to make the issue part of budget negotiations.

Among other moves, Storms passed around a Miami Herald story showing a Miami doctor had ignored scores of letters — and three office visits — from state health regulators who warned his mental health drug prescribing practices were potentially dangerous. One of the doctor’s patients, a disabled 12-year-old, died of complications from over-medication.

But the House balked at every turn.

Sen. Nan Rich from Weston, who will become the ranking Democrat next year, said the Houses’s failure to take up the bill will allow future child welfare administrators to “once again fall back into the path of least resistence” by using mental health drugs as a chemical restraint on unruly foster kids.

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Amendment to bill targeting foster kids’ medication draws fire


Miami Herald

Critics are questioning an amendment to a bill designed to protect foster children from being inappropriately medicated with mental-health drugs.
BY CAROL MARBIN MILLER

One of the largest providers of inpatient psychiatric care for Florida foster kids successfully pushed for an amendment to a bill that will make it easier for group homes and treatment centers to begin medicating foster children without the consent of a parent or judge.

Psychiatric Solutions, which operates 13 residential treatment programs in Florida, including three in Broward County, proposed an amendment to state Sen. Ronda Storms’ bill that will allow the company, and others like it, to administer mental-health drugs to young foster children for three days without the consent of a parent or judge. The legislation was prompted by the 2009 death of a 7-year-old Margate foster child, Gabriel Myers.

CONSENT NEEDED

Under current law, and under the bill that Storms, a Valrico Republican, proposed, children younger than age 11 in the care of the Department of Children & Families cannot be given psychiatric drugs without the consent of a parent, or a state judge in cases where the child’s parents have lost their parental rights.

In her bill, Storms proposes that caregivers for foster children must present a “compelling government interest” that medication is in the “child’s best interest.” The bill requires DCF to get an independent review in order to medicate children younger than 11.

In an e-mail to DCF’s legislative affairs director, Jim R. Henry, the director of Manatee Palms Youth Services, which is owned by Psychiatric Solutions, suggests that the state has, by definition, a compelling interest in allowing children to be medicated at treatment centers, since the kids already are presumed to be mentally ill.

Jeff Turiczek, who runs Manatee Palms, wrote in a March 26 e-mail that the amendment “basically [makes] the case that by the admissions requirements into those facilities the compelling governmental interest has been met.” In other words, a child entering a treatment center or therapeutic group home already has been diagnosed with a mental illness, and therefore may need to be medicated. Turiczek did not return calls seeking comment.

Storms said Friday she did not amend her bill to benefit the company. “It is true lobbyists come to see me,” Storms said. “No one said, hey will you do this from PsychSolutions, or whatever. I’m not trying to do it for any singe entity’s benefit. I am saying I want to fend off as much of the opposition as I can, so it gets through.”

Storms’ bill requires that doctors receive informed consent from a parent or guardian before administering mental-health drugs.

But the bill, as amended by Storms on Tuesday, makes exceptions: Doctors may begin the use of psychiatric drugs, without consent or a court order, if a child is in a mental hospital, a crisis stabilization unit, a residential treatment center or therapeutic group home. In such settings, DCF must seek a court order to administer the drugs within three days of beginning the medication.

Critics of the amendment note that children in such institutional settings are the most at risk of being inappropriately medicated.

In May 2009, during DCF’s investigation into the use of psychotropic drugs, the agency reported that 26 percent of children in group homes or other institutional settings were being given mental-health drugs, compared to 21 percent of children in foster homes and 4 percent of children living with relatives.

Jim Sewell, a special assistant to DCF Secretary George Sheldon who chaired a task force last year that looked into the use of mental-health drugs among foster kids, said supporters of the amendment had not spoken to him about it. “It was kind of a surprise,” he said.

“The language can be better, a lot of us believe. But rule-making authority will enable us to put things in place that ensure the protection of kids,” Sewell said.

Another member of the Gabriel Myers Work Group has expressed misgivings about the amendment. Gabriel died a year ago Friday after hanging himself in a foster home shower. He had been prescribed several mental-health drugs in the months before his death, including anti-depressants linked to an increased risk of suicide among children.

“The fact that a child needs residential treatment is not per se sufficient to say they need medication,” said Robin Rosenberg of Florida’s Children First. “I think there is too much potential for abuse.”

PROTECTING KIDS

Storms, who has been extremely vocal about her concern that doctors are relying far too heavily on drugs to manage troubled foster kids without first attempting other methods, said doctors still will have to seek consent from a judge. Storms said the bill will better protect children than current law.

She said she added the amendment to drum up more support for the bill, as she had received a number of calls from concerned treatment centers that they would not be able to medicate if a child were pulling out their hair, cutting themselves, or banging their head on a table without end.

Miami Herald staff writer Robert Samuels contributed to this report.

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FDA warns psychiatrist who treated dead foster child

Miami Herald
BY CAROL MARBIN MILLER

MENTAL HEALTH
FDA warns psychiatrist who treated dead foster child
The psychiatrist who treated the Broward foster child who killed himself last year is now in hot water with the FDA.

A South Florida psychiatrist who was treating a 7-year-old foster child before the boy committed suicide last year has received a warning from federal drug regulators who say he failed “to protect the rights, safety and welfare” of children enrolled in clinical drug trials.

In a strongly worded letter dated Feb. 4, regulators at the U.S. Food and Drug Administration said Dr. Sohail Punjwani over-medicated children who were enrolled in clinical trials for undisclosed drugs. One girl, the letter said, slashed her wrists while hallucinating.

Another, a 13-year-old, “experienced sedation and dizziness during the study,” the letter said.

The warning letter, a harsh and rare form of discipline by the agency, says Punjwani failed to “adhere to the applicable statutory requirements and FDA regulations governing the conduct of clinical investigations.”

“Your failure to conduct the requisite safety measures contributed to the unnecessary exposure of pediatric subjects to significant overdoses, which jeopardized the subjects’ rights, safety and welfare,” the letter says.

Punjwani did not return calls from The Miami Herald seeking comment.

Punjwani, who practices in Tamarac and has offices elsewhere in South Florida, was treating 7-year-old Gabriel Myers when the boy hanged himself with a shower cord in a Margate foster home. The boy’s death prompted a yearlong probe by a Department of Children & Families task force, as well as proposed legislation before the Florida Senate.

Before Gabriel’s death, Punjwani had prescribed several powerful mental health drugs — some of which had not been approved by the FDA for use on children and had been linked to dangerous side effects, including an increased risk of suicide among children.

Punjwani also was sued last summer by a Tamarac mother who claims her son, 16-year-old Emilio Villamar, died after being over-medicated with a group of mental health drugs at a Fort Lauderdale psychiatric hospital.

The letter mailed to Punjwani does not specify the names or types of drugs the doctor was testing, and a spokeswoman for the FDA, Sandy Walsh, said such details are kept confidential to protect drug companies.

Walsh said the FDA does not send out such warning letters often, and the agency considers breaches of its regulations to be “very serious.” The letter was signed by Leslie K. Ball, a doctor who heads the compliance office of the Division of Scientific Investigations, and Constance Cullity, a doctor who is also a compliance officer.

For years, drug makers did not study most medications on children, largely due to ethical concerns over using kids as test subjects. More recently, however, Congress passed laws to encourage pharmaceutical companies to test their drugs for safety and efficacy with children by extending patents on drugs approved for adults.

In a trial for one drug that was not identified, Punjwani gave one child dosages “in excess of… specified limits,” the letter says.

The child was discontinued from the trial before it was completed, the letter says, “due to worsening auditory hallucinations that apparently caused the subject to lacerate her wrists.” The girl was “overdosed” on the drug for more than two weeks.

The letter says Punjwani submitted a corrective action plan to the FDA and revised his procedures to better protect his research subjects from dosing missteps. “However,” the letter says, “we are concerned that the response is not adequate to prevent future recurrence of the violation.”

The clinical trials for a different drug were to adhere to a series of protocols that specified what dosage of the drug was to be used, depending on the child’s weight, the letter states. But for six of seven children — chosen at random — who received one of the tested drugs in Punjwani’s study, the dosage exceeded what was spelled out in the protocol.

One child who weighed 103 pounds, for example, “was overdosed on study medication for 20 consecutive days while participating in the study,” the letter states. The child is identified only as “Subject 1001.”

A child identified as “Subject 1003,” who was 15 at the time of the trials, “was overdosed on study medication for 21 consecutive days while participating in the study,” the letter says. “Subject 1004,” a 16-year-old, “received doses in excess of the maximum target dose for 3 consecutive days while participating,” the letter says.

A 10-year-old, identified as “Subject 1007,” was “overdosed” for nearly two weeks while on the study, the letter states.

Department of Children & Families Secretary George Sheldon, who appointed a task force last year to study Gabriel’s death, said Monday he is asking the FDA to compare a list of Florida foster children with lists ofchildren enrolled in Punjwani’s clinical trials. Sheldon said he was acting on concerns that children in state care may have been involved in clinical trials, which is against state law.

The FDA letter, Sheldon said, “raises clear ethical issues and judgment issues that we need to clearly understand.” If foster kids were enrolled in clinical trials, he said, “we will need to take it to another level.”

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Regulations sought for foster kids prescribed psychiatric drugs

Miami Herald
FLORIDA LEGISLATURE

In the wake of a Broward child’s death, state lawmakers will consider a bill designed to make it harder for child welfare workers to use mental health drugs to control foster kids.
BY CAROL MARBIN MILLER

Florida lawmakers will once again consider a measure to rein in the use of psychiatric drugs among foster children in the wake of last year’s death of a 7-year-old Broward boy who was on a cocktail of mood-altering drugs.

A new bill, filed Friday by state Sen. Ronda Storms, a Brandon Republican, would, among other things, require that foster children assent to the use of psychiatric drugs. The proposed law would require caseworkers to explain to children, in a manner they can understand, why the drugs are necessary and what risks they carry.

“It’s a huge step forward for the children of Florida,” Robin Rosenberg, deputy director of Florida’s Children First, said of the provision. “It’s integral to effective treatment for children to be involved at a developmentally appropriate level.”

The requirement that foster kids be involved in their own treatment was one of scores of recommendations made by a child welfare work group of administrators from the Department of Children & Families, doctors and children’s advocates who studied the death of Gabriel Myers last April.

Gabriel, originally from Ohio, entered state care in June 2008 when his mother was found slumped in her car in a restaurant parking lot — with a narcotic pill bottles surrounding her. Gabriel hanged himself on April 16, using a retractable shower cord as a noose.

In the aftermath, The Miami Herald reported that the boy had been prescribed several anti-psychotic and anti-depressant drugs in the months before his death. Most of the drugs have not been approved for use with children, and some have been linked to serious side effects, including an increased risk of suicide.

While Storm’s bill tracks most of the work group’s findings, it differs in some respects. One major difference: The work group wanted each child being administered psychotropic drugs to have the benefit of a lawyer at all court appearances.

Storms’ bill requires the state to appoint guardians ad litem, or volunteer lay guardians. Storms said the guardians are qualified for the role because they already are involved in the children’s lives.

Rosenberg, who was a member of the Gabriel Myers Work Group, said “the work group concluded that attorneys are best suited to protect children’s interests when prescribing medication,” she said.

The bill would also:

• Prohibit children in state care from being involved in clinical trials designed to determine the safety or efficacy of drugs that have not yet been approved by the FDA.

• Require an independent medication review before psychiatric drugs can be administered to children 10 or younger.

• Require mental-health professionals to prepare an overall treatment plan, including the use of counseling and therapy, when children are prescribed psychiatric drugs.

“We want to give a preference to behavioral therapy,” said Storms, the bill’s sponsor. “We’re not going to just drug them through their childhood and adolescence.”

Storms said she thought the prescribing of such drugs has become a crutch for therapists, who are eschewing traditional couch chats with children. Research shows, she said, that some doctors are writing one prescription for a child every three minutes.

DCF administrators have supported the legislation, which marks the second time this decade that lawmakers have sought to crack down on mental-health drug use among kids in state care.

“With young kids, we really need to err on the side of caution,” said DCF Secretary George Sheldon, who has supported both the work group and the legislation.

State Sen. Nan Rich, a Sunrise Democrat who is vice chair of the children’s committee, said the bill will fail if lawmakers decline to set aside enough money to pay for it — especially the provision that requires guardians for foster kids who are prescribed drugs.

Miami Herald staff writer Robert Samuels contributed to this report from Tallahassee.

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Autopsy proves foster child hanged himself; why is a mystery

Miami Herald

The autopsy on 7-year-old foster child concludes Gabriel Myers hanged himself, though his reasons will forever remain unknown.
BY CAROL MARBIN MILLER

Gabriel Myers, the 7-year-old foster child whose death sparked a statewide inquiry, died of asphyxiation after hanging himself, the Broward medical examiner’s office has ruled, though authorities say they will never know whether the youngster meant to kill himself.

Weeks before Gabriel roped a shower cord around his neck in the bathroom of his Margate foster home on April 16, the little boy choked himself at school, the report noted.

“Although the investigation suggests that he alone took the actions that resulted in his death, his psychiatric history suggests that this fatality may represent a tragically flawed attempt [at] self-injury for secondary gain,” states the ME’s report, written by Deputy Chief Medical Examiner Stephen J. Cina.

Gabriel entered state care in June 2008 after police found him in a parked car with his mother, who had passed out behind the wheel.

Police found an abundance of Xanax and other prescription drugs in the car. Authorities suspected Gabriel had been abused, as he had bruises, bites and other marks on his body.

One of the key issues prompting DCF’s detailed review of his death was the administration of several powerful mood-altering drugs on the boy, including two — an anti-psychotic and an anti-depressant — linked by the FDA to an increased risk of suicide among children.

In his report, Cina concludes there is no way to determine whether the medications were linked to Gabriel’s death.

“While several medications in [Gabriel's] blood have been associated with an increased risk of suicide in some cohorts, it cannot be proven that their presence played a role in this fatality,” Cina wrote.

Cina’s report states a “well-documented absence” of suicidal thinking on Gabriel’s part as evidence that the boy may have meant only to gain attention when he wrapped the shower cord around his neck. Cina cites a 29-page report on the boy’s death by a work group appointed by DCF Secretary George Sheldon.

But a timeline of the boy’s case — also prepared by the work group, though not attached to the final report — states that on March 31 Gabriel’s caseworker received a call from the boy’s school saying that “he was out of control and destroying school property and stating that he wanted to kill himself.”

That same day, progress notes say, Gabriel was taken to his psychiatrist, who said the boy did not have any thoughts of killing himself or others.

The autopsy report documents several bruises on the boy’s body, including “extensive” bruising along Gabriel’s legs.

A Margate police detective investigating the boy’s death said Thursday that an expert who consulted on the case attributed the bruises to the normal activities of an active boy.

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Report: Fla. boy may not have meant to kill self

Miami Herald

By KELLI KENNEDY
Associated Press Writer
FORT LAUDERDALE, Fla. — It is unclear whether powerful psychotropic medications played a role in the death of a 7-year-old foster child, and the boy may have hanged himself for attention, according to a medical examiner’s report released Thursday.

Gabriel Myers locked himself in a bathroom and hanged himself with a shower cord in April, but the report classifies his death as undetermined. The report says it’s possible Gabriel did not intend to kill himself and did not fully understand the finality of his actions.

“His psychiatric history suggests that this fatality may represent a tragically flawed attempt of self-injury for secondary gain,” Dr. Stephen Cina, Broward County’s deputy chief medical examiner, wrote in the report.

Gabriel was on several powerful psychotropic medications, including Symbyax, before his death. That drug carries a U.S. Food and Drug Administration “black box” label warning for children’s safety and increased risk of suicidal thinking. It is not approved for use with young children. But doctors often prescribe them off label.

The boy’s death prompted debate at the state’s child welfare agency about stricter rules for prescribing powerful antidepressants and other drugs to foster children. The drugs affect the central nervous system and can change behavior or perception. They are prescribed for depression, anxiety, schizophrenia and other psychiatric conditions. Some are used to alleviate pain.

Critics say the drugs are overused as a chemical restraint for unruly children. A report by the Department of Children and Families released earlier this year indicates the 2,699 children taking psychotropic drugs account for 13 percent of all Florida children in out-of-home foster care. That compares with only an estimated 4 percent to 5 percent of children in the general population.

A records check showed that 433 of those children, or 16 percent, had not had their drugs approved by parents or court orders.

“Psychotherapeutic medications are often being used to help parents, teachers and other child workers quiet and manage, rather than treat, children,” according to an August report released by a panel that studied the Gabriel’s death.

DCF Secretary George Sheldon has said he may recommend further review for all children in state custody on such medications and the appointment of a new in-house state medical director to keep tabs on cases.

The task force also said case workers, doctors and teachers failed Gabriel at several points along the way and ignored warning signs. He was in three different foster homes, switched therapists and medications, and touched classmates in a sexually inappropriate way. He also tried to strangle himself in December, leaving noticeable red marks and scratches on his neck.

Gabriel also had several blunt force injuries at the time of his death, including bruises on his knees, thighs and forehead, according to the report.

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Senator: drug companies “can lobby all they want. They can’t stop this.”


Miami Herald

Foster kids, prescriptions — finally alarm
By FRED GRIMM

Gabriel Myers finally matters.

Too late for him — the foster kid we addled with anti-depressants and anti-psychotics without quite knowing the effects drug cocktails might have on a 7-year-old.

One potential side effect of feeding Lexapro, Zyprexa and Symbyax to a 67-pound child became grotesquely obvious. Young Gabriel coiled a shower hose around his neck and hanged himself in the bathroom of his Miramar foster home.

Gabriel’s death on April 15 roiled child advocates, critics of the pharmaceutical industry, the media. But this week, a child’s suicide finally elicited a reaction where it matters.

“I tell you, we’re going to do something. We’re going to do a full-court press,” said State Sen. Tony Hill, a Jacksonville Democrat, still shocked after members of the Senate Children, Families and Elder Affairs Committee were briefed Wednesday by the Gabriel Myers Task Force.

UNACCEPTABLE

Committee Chair Rhonda Storms, a Valrico Republican, told reporters, “I cannot accept or believe that a little child cannot be reached except by drugging him and drugging him and drugging him.”

The task force catalogued drug regimens for foster children that the FDA never approved for children. It described a system blighted by haphazard oversight. No one within the child-care bureaucracy took direct responsibility for the child’s complex psychological needs. No one was looking out for a profoundly troubled child’s best interest.

Hill railed that Gabriel’s foster parents, schools, case workers and doctors hardly spoke to one another as his problems escalated. “No communication,” he said, his voice rising in anger.

No one acted as a parent. A vigilant, caring parent would have questioned a pharmaceutical solution to the little boy’s behavior. Child advocate Andrea Moore read the task force report and worried that the doctors had responded more to bureaucratic needs of the system than the therapeutic needs of children. About 22 percent of the foster children aged 6 to 12, and a third of foster kids 13 to 17, are on psychiatric drugs. Such numbers, utterly out of whack with the general population, defy any explanation other than foster kids were to be transformed into compliant little zombies.

“We’re going to find out,” Hill promised, describing a bipartisan fury.

“We’re going to find out why doctors are writing these prescriptions, and we’re going to find out about the relationship between the doctors and drug companies.”

`MAJOR CHANGE’

Advocates like Moore have long complained that state foster care facilities administered psychotropics in lieu of providing real therapy. Five years ago, the Legislature passed supposed safeguards to rein in the pill madness. Obviously, they didn’t work.

Meanwhile, pharmaceutical companies have been encouraging doctors to prescribe unapproved, off-label uses for their expensive, profitable drugs.

DCF has promised to revisit psychotropics regulations. Hill promised tough legislation. “Major, major change is coming. The whole committee is behind this.” He said drug companies “can lobby all they want. They can’t stop this.”

It took the death of a child to arouse the legislators. “I admit, I didn’t know this was going on before Gabriel,” Hill said, using the boy’s name to describe a tragic event. “That should never have happened to a child.”

But now, hopefully, it matters.

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